Darvish Cyrus J, Lagerman Nicholas P, Virag Oldrich, Parks Hannah, Pandya Yash K, Eslami Mohammad H, Vorp David A, Chung Timothy K
Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
School of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
J Vasc Surg Cases Innov Tech. 2024 Oct 28;11(1):101661. doi: 10.1016/j.jvscit.2024.101661. eCollection 2025 Feb.
Abdominal aortic aneurysm (AAA) is the focal dilation of the terminal aorta, which can lead to rupture if left untreated. Traditional endovascular aneurysm repair techniques are minimally invasive and pose low mortality rates compared with open surgical repair; however, endovascular aneurysm repair procedures face challenges in accommodating variations in the patient's anatomy. Complex aneurysms are defined when the sac extends past the renal arteries or has an insufficient neck landing zone to deploy a traditional endograft. Fenestrated endografts were introduced to enable the repair of complex aneurysms by the creation of fenestrations to enable blood flow into the visceral arteries. This study investigates proof of concept for creating antegrade in situ fenestrations of off-the-shelf endografts using a novel endovascular orifice detection device. Our technique enables the precise location of the visceral artery orifices using fiber optic cables and an infrared light source. The endovascular orifice detection device was tested rigorously in precisely locating an artery opening in blood and a custom AAA phantom model. The study also explored the safest means of creating a fenestration using mechanical puncture and a laser. This innovative approach offers a viable alternative for patients with complex AAAs.
腹主动脉瘤（AAA）是腹主动脉末端的局限性扩张，如果不治疗可能会导致破裂。与开放性手术修复相比，传统的血管内动脉瘤修复技术具有微创性且死亡率较低；然而，血管内动脉瘤修复手术在适应患者解剖结构的变化方面面临挑战。当瘤体延伸至肾动脉以下或颈部着陆区不足以部署传统血管内移植物时，即定义为复杂动脉瘤。带开窗的血管内移植物被引入，通过创建开窗以使血液流入内脏动脉，从而实现对复杂动脉瘤的修复。本研究调查了使用新型血管内孔口检测装置对现成血管内移植物进行顺行原位开窗的概念验证。我们的技术利用光纤电缆和红外光源能够精确确定内脏动脉孔口的位置。该血管内孔口检测装置在精确确定血液中的动脉开口以及定制的AAA模型中进行了严格测试。该研究还探索了使用机械穿刺和激光创建开窗的最安全方法。这种创新方法为患有复杂腹主动脉瘤的患者提供了一种可行的替代方案。
